My patient is older and hard of hearing, and masks aren’t helping the situation. I raise my voice so he can hear me, which means I lose a lot of nuance and expression in my tone. Within a few minutes, he allows his mask to droop below his nose, as if trying to show me I should do the same — a common occurrence and why I wear a fit-tested N95 for all patient encounters.
I ignore the sagging mask and do my best to answer his questions, but he doesn’t allow me to complete a sentence. He’s angry, and he has every right to be. Anger about a cancer diagnosis is common and a normal human reaction.
But it soon goes beyond that.
“Move that button so I can see your name,” he demands, interrupting me again.
I glance down. I have a button pinned to my badge that reminds patients to get their COVID-19 booster, a life-saving intervention for our immunosuppressed oncology population. It slightly overlaps my first name, but I’ve made sure my last name remains clearly visible.
But, to appease him, I lift up the button.
He scrutinizes my badge.
After a moment, I release it and attempt to continue the visit.
“Let me see that again,” he says immediately.
I pause, trying to figure out what this is all about.
“My name didn’t change in the last minute,” I assure him, trying for levity.
At this point, his relative, a large-framed middle-aged man sitting with his hands on his knees, leaning forward to glare at me, raises his voice. “Lift it up! Who cares if your name hasn’t changed! He’s asking you to do it, and isn’t that what this is all about? To make him happy? In fact, just take that button off! Now!”
What’s going on here? I consider the situation. Are they anti-vaxxers? Are they offended by the message on the button?
I am certainly offended by the way they’re speaking to me. I’m both amazed and yet not surprised that this still happens to me, a 48-year-old woman who’s been a practicing physician, post-fellowship training, for 16 years.
I dig deep and rely on that training. I’m here to provide a service as a physician, to discuss care options for a fellow human being. I can do that, no matter how they treat me. I can rise above.
I remove the button and put it in my pocket.
It then immediately becomes clear why he wanted me to remove it.
“Jennifer,” my patient says with a note of disdain, reading my first name off my badge with exaggerated slowness.
He continues to interrupt me for the remainder of the visit, punctuating each interruption with my first name. “Is that what you really think, Jennifer?” “Isn’t that what you just said, Jennifer?“
His relative now sits back in his chair, arms crossed, a satisfied air about him.
They weren’t objecting to the vaccine message on my button. They were objecting to not being granted easy access to my first name in order to untitle me.
Why didn’t you correct him and ask him to address you with your title and last name? I hear you asking.
It’s not that simple. Like every woman in medicine I know, this has happened to me countless times. I’ve tried all different approaches. The direct approach, the lighthearted approach, the explanatory approach, the offended approach — and I’ve found that’s what they want. They want to know that I’ve noticed, and it’s gotten to me.
So, most of the time, I choose to ignore it and try to keep going with the visit.
Under Threat
I wrote the first draft of this essay the day before the murder of an orthopedic surgeon, as well as another physician and two other people, in Oklahoma, at the hands of a disgruntled patient.
Along with many colleagues, I’m replaying in my head prior difficult patient situations like the one above. How would I have handled it differently if it had taken an even worse turn?
If the scenario above had happened the day after the events in Oklahoma, would I have walked out? Told them they needed to find another physician? Would that only have made them angrier? What if the patient or his family member had a gun?
Years ago, as a trainee, I was physically assaulted by a patient, and my team made me feel like I was making a big deal over nothing. I wrote about that in 2018, along with other examples of harassment by patients (none of them involving guns).
I’ve worked in more than one clinic over the past 10 years where an angry patient called in a gun threat to a triage nurse. I’ve never worked in a clinic where we had a concrete plan of what we would do if this threat materialized.
At the same time, those of us who are parents would take a shooting at our workplace over a shooting at our kids’ schools any day.
We already know that physicians who experience mistreatment and discrimination by patients, their families, and visitors are more likely to have symptoms of burnout.
My patient’s relative told me it was “my job” to “make him [the patient] happy.” Was it, though? Even when it entailed allowing him to verbally abuse me?
Is it a physician’s job to make their patients happy?
We strive to make our patients feel listened to, validated, respected, and given agency in choosing their treatment options. There are times we’re probably not entirely successful in achieving these goals because of the external pressures that constrain our time with patients, and cause physician burnout.
Unfortunately, some of what we do as oncologists doesn’t lend itself to happiness. We practice evidence-based medicine and have spent decades attaining the knowledge to practice in our specialties. What would happen if a patient demanded to be given inappropriate treatment at gunpoint?
I fear that the pandemic of gun violence, like the COVID-19 pandemic, will only add to the exodus of healthcare workers.
Originally published on Medscape Blogs June 20, 2022